title: A review of cognitive therapy in acute medical settings. Part II: strategies and complexities.
abstract: OBJECTIVE
  Cognitive therapy (CT) has considerable utility for psychosomatic medicine (PM) in acute medical settings but, to date, no such cohesive adaptation has been developed. Part I delineated a CT model for acute medical settings focusing on assessment and formulation. In Part II, we review how CT can be applied to common PM clinical challenges. A pragmatic approach is helpful because this review targets PM trainees and educators.
  
  
  METHODS
  Narrative review is used to discuss the application of CT strategies to common challenges in acute medical settings. Treatment complexities and limitations associated with the PM setting are detailed. Exemplary dialogues are used to model techniques.
  
  
  RESULTS
  We present CT approaches to eight common scenarios: (1) distressed or hopeless patients; (2) patients expressing pivotal distorted cognitions/images; (3) patients who catastrophize; (4) patients who benefit from distraction and activation strategies; (5) panic and anxiety; (6) suicidal patients; (7) patients who are stuck and helpless; (8) inhibited patients. Limitations are discussed.
  
  
  CONCLUSIONS
  A CT informed PM assessment, formulation and early intervention with specific techniques offers a novel integrative framework for psychotherapy with the acutely medically ill. Future efforts should focus on dissemination, education of fellows and building research efficacy data.
authors.affiliation: Department of Psychiatry and Behavioral Science, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. levint@mskcc.org
authors.forename: Tomer T
authors.initials: TT
authors.lastname: Levin
authors.forename: Craig A
authors.initials: CA
authors.lastname: White
authors.forename: Philip
authors.initials: P
authors.lastname: Bialer
authors.forename: Robert W
authors.initials: RW
authors.lastname: Charlson
authors.forename: David W
authors.initials: DW
authors.lastname: Kissane
mesh_terms: D000208:Acute Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004645:Empathy; D006801:Humans; D007406:Interview, Psychological; D008960:Models, Psychological; D011611:Psychosomatic Medicine